Intestinal parasites co-infection and associated factors among active pulmonary tuberculosis patients in selected health centers, Addis Ababa, Ethiopia: unmatched case control study

Ayinalem Alemu,Getu Diriba,Bazezew Yenew,Mengistu Tadesse,Misikir Amare,Biniyam Dagne,Kassu Desta,Ephrem Tesfaye,Waganeh Sinshaw,Abebaw Kebede,Dawit Challa

doi:10.1186/s12879-019-4009-0

Ayinalem Alemu, Getu Diriba + Show 9 more

Open Access

https://doi.org/10.1186/s12879-019-4009-0

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Abstract

BackgroundIn co-endemic areas, rate of intestinal parasites and tuberculosis (TB) co-infection thought to be high. However, there are limited studies on the epidemiology of this co-infection in Ethiopia. Therefore, the present study aimed to generate evidence on intestinal parasites co-infection rate and associated factors among pulmonary tuberculosis patients (PTB) and their household contacts in Addis Ababa, Ethiopia.MethodsUnmatched case-control study was conducted. Data were collected from 91 PTB patients (cases) and 89 household contacts (controls). Socio-demographic characteristics and associated factors were collected using structured questionnaire. Sputum, stool and blood specimens were collected, processed and examined for PTB, intestinal parasites and Human Immunodeficiency virus anti-body test, respectively. Data were entered and analyzed by Statistical Packages for Social Sciences (SPSS) Version 20. Descriptive statistics, Fisher’s exact test, binary logistic regression, and odds ratio were used. P-value of < 0.05 was considered as statistically significant.ResultsThe infection rate of intestinal parasites based on one stool samples in PTB patients and controls was 22 and 9%, respectively. The difference was statistically significant (COR = 2.85;95% CI = 1.18–6.87). The most prevalent intestinal parasite in PTB patients was Gardia lamblia (8.8%, 8), followed equally by Ascaris lumbricoides, Haymenolopsis nana and Entamoeba histolytica/dispar (4.4%, 4). Co-infection in PTB patients was associated with body mass index (BMI) < 18.5 (AOR = 6.71;95% CI = 1.65–27.25) and dirty material in finger nails (AOR = 8.99;95% CI = 2.46–32.78). There was no variable associated with parasitic infections in controls in our analysis, which might be due to the low prevalence of intestinal parasites’.ConclusionsThere was a statistical significant difference in the infection rate of intestinal parasites in PTB patients compared to healthy household contacts. The consequence of co-infection on developing an active disease, disease severity and treatment efficacy needs to be investigated in future.

Highlights

In co-endemic areas, rate of intestinal parasites and tuberculosis (TB) co-infection thought to be high
Lowenstein Jenson (LJ) slants were incubated at 37 °C, while Mycobacterium Growth Indicator Tube (MGIT) tubes were loaded to MGIT 960 instrument (Becton-Dickinson and Company, Sparks MD)
Socio-demographic characteristics A total of 190 study participants were enrolled in this study; of them 99 were cases with bacteriological confirmed active Pulmonary Tuberculosis (PTB) and 91 were controls that were healthy household contacts to TB patients

Summary

Introduction

In co-endemic areas, rate of intestinal parasites and tuberculosis (TB) co-infection thought to be high. It was reported that intestinal parasites (IP), helminthes causes immune activation with biased T helper 2 responses and down regulated Th1 and Cytolytic T lymphocytes activity [6]. This change in the immunological milieu of the host might impair the immunological response to pathogens which need Th1 responses to limit the severity and progression of infection [6]. In sub-Saharan Africa, where the prevalence of parasitic infections is very high, a dominant Th2 polarized immune response has been reported and suggested to increase susceptibility to MTB [3, 7]

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